Special Theme ± Immunization Safety

Round Table Discussion Presenting the case various levels were given special training in signs and for an immunization safety symptoms to look out for. Seven serious events and many minor ones surveillance system were discovered through this surveillance system Ahmed A. Darwish1 between July 1998 and September 1999. No problems were encountered, and the situation was controlled and contained without any negative Brian Ward is to be congratulated on stating so clearly impact. There was a rapid response to the need for the reasons for a monitoring system being necessary investigation and management of cases, and for for any adverse events that could be related to satisfying the local community and parents that vaccination (1). I believe the reticence of govern- proper care was being taken. ments about inaugurating surveillance systems has Our experience in Egypt indicates the impor- several causes. First, although WHO encourages its tance of having a comprehensive system for Member States to develop and sustain a monitoring surveillance of adverse events following immuniza- system, they still do not see the need for such a tion, and I should like to encourage other countries to system or the value of it very clearly. Second, health go ahead with similar plans. The reservations I departments are concerned that systematic searching enumerated in my first paragraph have proved for adverse events related to vaccination might have a unfounded, and even people who were initially negative impact on their immunization programmes, sceptical have seen the value of our activities. by giving the impression to immunization teams that Nevertheless, I would like to propose a change in the vaccines are not safe, contrary to what they had the terminology. The term ``Immunization Safety learnt during training. In addition, asking questions in Surveillance System'' would be more suitable and the community might prompt people to think that positive, as ``adverse events'' has negative connota- something wrong with the vaccines, concealed from tions especially when translated into some other the users, is the reason for data being collected, even languages, such as Arabic. n though the vaccines have been in use for a long time without the issue being raised. 1. Ward BJ. Vaccine adverse events in the new millennium: is there The importance of surveillance of adverse reason for concern? Bulletin of the World Health Organization, events following vaccination was not widely recog- 2000, 78: 205±215. nized in Egypt until April 1998 when a few adverse events occurred in one governorate and were considered to be vaccine-related. The media received information about these cases before the medical A viewfrom the media authorities did, as at that time there was no surveillance system for such occurrences. Irrespon- on vaccine safety sible handling by the media caused rumours to spread Phyllida Brown1 that the vaccine was unsafe. This tarnished the reputation of the immunization programme, led to In general, the contribution of the media to increasing community panic, and had a negative effect on the parents' awareness of the dangers Brian Ward coverage for all seven antigens included in Expanded mentions (1) can be seen in a positive light. Programme on Immunization (EPI) activities all over Nevertheless, for anyone who lives in the industria- the country. lized countries, vaccine safety stories seem to appear After that, the Ministry of Health decided to in the media as frequently as food scares. In the establish a comprehensive system for the surveillance developing world such stories are rarer but certainly of adverse events following vaccination aimed at not unknown. Public health officials, aware of real detecting such events early so that they could be problems such as the recently withdrawn rotavirus investigated and proper action could be taken. The vaccine in the USA, must take all doubts about safety system was established with a central surveillance seriously. But when they watch immunization rate